The hidden crisis within the health care crisis

My first year after completing surgical residency was an exhilarating and exhausting experience that most physicians will recall as part of their training. The American medical culture has imagined that the nation’s doctors — no matter their workload — simply don’t reach physical or emotional exhaustion in their work. But they do, and as we debate the future of healthcare in our country, we need to address this problem and quickly get to solutions, helping ensure that the practitioners closest to tomorrow’s patients can always be at their absolute best.

To define the problem, look at the three fundamental factors common to any American doctor’s routine:

Always on. The medical occupation is one of very few where the professionals never work a shift or a predictable, set period — nor are they ever expected to. Once engaged in treating a patient, doctors work round-the-clock to ensure the patient receives quality care — often days straight in the most critical cases, snatching the 15-minute gurney naps many Americans know from medical procedurals on TV before plunging back into surgery.

Head and heart. Our professional oath compels us to adhere to ethical standards that put patients first. As with the commitment to work-until-the-work-is-done, this kind of dispassionate commitment is not just routine but expected. However, while “toughness” is valued in the profession and the emotional elements may not be widely discussed, they do exist — they always have — and they add up. As patients, we regard our doctors to be professional, rational superheroes. But as human beings, we need to recognize that our doctors are human beings, too, and face similar stressors outside of work like the well-being of our own children.

Broader systems. The healthcare system is incredibly complex, and while doctors are a component of this system, their work is impacted by other elements within the system and by broader social, legal and economic forces. From running their own practices, negotiating contracts with payers or working in an administrative environment where things don’t move as efficiently as you might expect, these external forces are an additional layer of pressure that can accelerate a doctor’s feelings of mental fatigue — especially because they are forces beyond the doctor’s own control.

These add up to a formidable reality for any practicing doctor and, indeed, an entire occupational culture. But I think there are four, manageable steps to begin making progress against this very real problem:

Recognition. More than half of U.S. physicians are now experiencing professional burnout. As a profession, we need to do a better job acknowledging this issue exists to remove the stigma and address the problem.

Transparency. What safe, healthy medical cultures across the country have in common is transparency. Any healthy culture has open communication, where people are comfortable to speak up, and staff are empowered to identify peers showing signs of stress and who may need help. At Hospital for Special Surgery, we have found this type of environment lowers workplace stress and creates a culture of safe, secure identification, where doctors know they can not only ask for help, but that others are looking out for them, too.

Quality. A rigorous quality program helps ensure that any hospital system has surveillance on outcomes, both good and bad, and can then diagnose individual outcomes to determine any patterns that warrant deeper examination. Without a commitment to quality, doubts can quickly become problems — and patients can begin suffering just as fast.

Treatment. As with any diagnosis, symptoms of burnout demand sustained, quality treatment, including access to psychologists, psychiatrists and other counselors without question or stigma — an indignity that has for decades kept people from asking for the help they need and deserve. At Hospital for Special Surgery, we have psychologists on staff to support our residents and attending doctors at all times.

To help ensure a sustainable, healthy occupational culture across the country, we must establish sector-wide protocols so that every doctor knows that the problem exists and that they can get help, as needed, without judgment and throughout their career. Similarly, hospital systems must re-commit to quality programs that support their doctors by helping identify opportunities before they become problems. America’s medical community deserves nothing less, because America’s patients deserve our best.